Surrogacy, the process in which a person other than the intended parent(s) carries a pregnancy, may be used by both heterosexual couples and LGBTQ couples, as well as single people. What are the different types of surrogacy? Why do couples choose surrogacy? What's the process — and how much does it cost? Here, we cover the basics you should get acquainted with if you are considering surrogacy.
Types of surrogacy: traditional vs. gestational
Before we jump into the surrogacy process and the cost of surrogacy, it's important to define the two types of surrogacy: traditional and gestational.
Traditional surrogacy is a process in which the surrogate uses their own egg to conceive the child, so the surrogate is the child’s biological mother. This is uncommon, and prohibited in many states.
Gestational surrogacy is a process in which the intended parents use an egg from a donor and create an embryo through in vitro fertilization (IVF). Then, the embryo is transferred into the surrogate's uterus. This means that the gestational surrogate is not genetically related to the child in any way.
Why do couples choose surrogacy?
For couples in which both partners produce sperm, such as gay male couples, surrogacy is one of the only options to start a family, if they want a child that shares one of their genetics. Surrogacy may also provide an option for heterosexual couples or single women who don’t have a uterus or who have uterine anomalies.
Couples may prefer surrogacy over adoption for a number of reasons. They may have the desire to have a child who shares their genetic makeup — the same eyes, nose, or smile. Surrogacy can make this dream a reality for gay couples and transgender women, as well as infertile heterosexual couples. It can also make it possible to have multiple children that are biological siblings.
Another reason people may consider surrogacy instead of adoption is so they can be more involved in the family-building process. With surrogacy, intended parents can select the surrogate they wish to carry their baby and be present for doctor's appointments and the birth of their child. That level of involvement isn't possible with adoption.
Finally, it can be more difficult for LGBTQ couples and single people to adopt. While a federal law required all 50 states to allow same-sex couples to adopt as of 2016, many states still allow discrimination in adoption placement. In some places, adoptions are managed by faith-based organizations, who often have unwritten or explicit rules against adoption or foster care by LGBTQ people.
Surrogacy considerations for same-sex couples
When both partners in a relationship produce sperm, you will need to decide whose sperm to use to attempt pregnancy with a surrogate. There are many personal considerations that weigh in this decision, including medical, family, and genetic history, and personal desire to have a biological child.
Starting with a semen analysis for both partners is a smart first step. The results can provide a detailed view of how healthy your sperm is, and which partner’s sperm is most likely to result in a pregnancy. You may find that you or your partner may want to work towards improving sperm health before beginning the surrogacy process.
These results help pave a clearer path so you can take control of the surrogacy process in a way that makes the most sense for your growing family.
Can both partners mix their sperm together to use with a surrogate?
This is a common question: In a couple of two sperm-producing people, can’t we just mix the sperm together so the biological parent of the pregnancy is a mystery?
For now, at least, the answer is no. If you use a fertility clinic, the person whose sperm is being used needs to consent and sign legal paperwork, so they must be identified. However, if both partners have viable sperm, you might consider having half of your donor’s eggs fertilized with one partner’s sperm, and the other half with the other partner’s.
Process of surrogacy
The entire surrogacy process, from surrogate matching to birth, can take anywhere from 15 to 20 months — sometimes shorter, sometimes longer. The surrogacy process is incredibly personal, so the timeline from one couple or person's journey to the next will differ. There are several steps you can expect during the process.
Choosing a surrogate
Most people choose to find a surrogate through a surrogacy agency. This is the easiest and fastest route, unless you have a friend or family member who has offered to act as a compassionate surrogate. If you choose to find your own surrogate, the legal paperwork as well as health screenings will be up to you.
If you use an agency, the speed at which you can be matched with a surrogate depends on how quickly you can complete required paperwork and screening and how strict your personal criteria are. Most agencies have screening processes for both the intended parents and gestational surrogate. Some common screening processes for intended parents include a background screening, psychological screening, genetic screening, and financial evaluation.
For a person to qualify as a gestational surrogate, they must meet certain criteria, such as:
- a history of least one healthy, full-term pregnancy and delivery
- no more than 2 previous c-sections
- a healthy BMI, and more.
Agencies may have age requirements for surrogates and also require psychological, medical, and background screenings.
Beyond these required criteria, couples may have additional preferences when choosing a surrogate. This might include wanting to be matched with a surrogate who lives within reasonable driving distance or a surrogate who is open to special requests, such as eating organic.
Gay couples and couples without viable eggs will need to find an egg donor. To keep the overall surrogacy timeline moving smoothly, it's recommended to simultaneously search for an egg donor while being matched with a surrogate. That way, you have a viable egg ready for IVF to match your chosen surrogate's cycle when it's time.
Alternatively, you can create embryos through IVF and freeze them. Then, you will have an unlimited amount of time to find a gestational surrogate.
If you are working with a surrogacy agency, they may have their own in-house egg donation services which will make selecting an egg donor easier. If not, there are a variety of ways you can find an egg donor. You can choose one through a fertility clinic or through a reputable egg donation program. Some intended parents may use an egg donor they personally know, such as a family member or close friend.
Negotiating agreement and contracts
Contracts are critical during the surrogacy process. This is why many couples choose to work with a surrogacy agency and speak with a surrogacy attorney. Even if your gestational surrogate is someone you know, such as a family member or friend, this step of the process is still important to protect your growing family.
The agreement will also outline how you plan to support the surrogate throughout pregnancy, answering questions such as:
- Does your surrogate have health insurance of their own, or will you be required to purchase insurance?
- What pregnancy expenses will you cover to support your surrogate? This can include items from maternity clothes to special foods or necessary medications.
- What happens if the surrogate doesn't get pregnant, or something goes wrong during the pregnancy or delivery? This likely isn't something you want to think about, but it's an important contingency to plan for.
Typically, there's a pre-planning period involved in IVF. This involves timing the cycle, screening tests (including infectious disease testing) for the parent who will be giving the sperm, and signing consents and other paperwork.
Once the cycle starts, in vitro fertilization with an egg donor and a surrogate has several steps:
- The egg donor will be prescribed injectable medication that stimulates their ovaries to produce multiple eggs in one menstrual cycle. The eggs will be retrieved surgically. This process takes about 2 weeks.
- In the lab, the eggs will be fertilized with the intended parent’s sperm to create embryos. At this point, many couples will do genetic testing on their embryos and/or freeze their embryos for future use.
- When the surrogate is ready, an embryo will be transferred into their uterus at the appropriate time in their menstrual cycle. If the embryo implants successfully, the surrogate will be pregnant.
Cost of using a surrogate
The average cost of using a surrogate in the U.S. ranges from $90,000–$130,000. Exactly how much your surrogacy will cost depends on several factors. The payment that surrogates personally receive ranges from $25,000–$50,000. The remainder of the cost of surrogacy includes:
- Egg donor compensation
- The IVF procedure
- Surrogacy agency and legal fees
- Health insurance or healthcare for the surrogate
- Pregnancy expenses
There are still other factors that influence the cost of surrogacy. For example, if you have employer benefits or health insurance that covers some of the costs of IVF, then you may be able to save on the total cost of surrogacy. If you have a family member or friend who is willing to act as a compassionate or altruistic surrogate (someone who is not compensated for surrogacy), then your surrogacy journey may be more affordable.
Remember that although the cost of surrogacy might seem alarming at first, many of those costs are there to protect you and your future child. Legal fees are necessary, and by pursuing surrogacy through an agency you will have experienced experts to guide you with your best interest in mind. Some agencies may have flexible payment plans as an option, too.
Surrogacy laws: what you need to know
While surrogacy may seem straightforward, the legalities of the process can become complex. Take the case of Baby M, for example. In 1988, a New Jersey couple who was struggling to conceive naturally entered an agreement with a traditional surrogate — meaning the surrogate's egg would be used to become pregnant. After childbirth, the surrogate changed her mind and wanted to keep the baby, claiming she had parental rights as the biological mother of the child. This matter went to litigation, and although New Jersey's Supreme Court ruled that the surrogacy contract was actually illegal, they granted parental rights to the intended parents.
The matter of Baby M was a long, emotionally draining case that received attention across the nation, leaving experts to question the ethics behind surrogacy. Some states, such as New York, prohibited surrogacy for decades. It was just recently that gestational surrogacy was made legal in New York — February 15, 2021. New York Governor Andrew Cuomo argued that the surrogacy ban was discriminatory towards same-sex couples, and new law was introduced with strict regulations on ethical surrogacy practices.
Currently, there are no federal laws in place that govern surrogacy, and each state has their own set of regulations.
States that prohibit surrogacy:
States where surrogacy is allowed, but legal verbiage may present hurdles:
These state-by-state differences and complexities are why it's recommended to hire a lawyer and work with a surrogacy agency. Although those expenses can make surrogacy costly, they are worth it to ensure peace of mind and a smooth process.
Success rates of surrogacy
The age of your gestational surrogate, egg donor, and parent who provides sperm are three factors that may affect surrogacy success rate.
Since the gestational surrogate is not a genetic contributor, the age of a gestational surrogate is not as critical. The age of the egg donor is actually the more important factor that determines the chances of successful, healthy pregnancy. It's recommended for gestational surrogates to be between 21 and 40 years old, and for egg donors to between the ages of 21 and 34.
Male fertility and sperm quality also declines with age. Pregnancy rates are higher for fathers under 35, compared to those in their late 30s and beyond. Therefore, paternal age may also impact success rates. Learn more about age and male fertility.
Overall, with a healthy egg donor and gestational surrogate, the success rate is very optimistic. According to the CDC, gestational carrier cycles have higher rates of implantation, pregnancy, and live births when compared to other IVF cycles. Gestational surrogacy has a success rate of 75% in the US.
Learn more about LGBTQ fertility options.